|
Tissue exam koh skin/hair/nails
|
$83.16 |
$83.16 |
$83.16 |
$47.40
|
|
Tobramycin non-comp unit
|
$27.73 |
$27.73 |
$27.73 |
$124.14
|
|
Tobramycin peak therapeutic drug level
|
$98.70 |
$98.70 |
$98.70 |
$118.30
|
|
Transferrin
|
$66.15 |
$66.15 |
$66.15 |
$85.56
|
|
Transfusion blood/blood component(s)
|
$917.70 |
$917.70 |
$917.70 |
$1,009.80
|
|
Treat eyelid by injection
|
$449.82 |
$449.82 |
$449.82 |
$441.68
|
|
Treat hip socket fracture
|
$808.92 |
$808.92 |
$808.92 |
$1,520.36
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$254.80 |
$254.80 |
$254.80 |
$203.35
|
|
Treponema pallidum antibody
|
$82.11 |
$82.11 |
$82.11 |
$73.45
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$70.66 |
$70.66 |
$70.66 |
$44.19
|
|
Triglycerides
|
$34.65 |
$34.65 |
$34.65 |
$55.90
|
|
Troponin quantitative
|
$129.15 |
$129.15 |
$129.15 |
$127.20
|
|
Ultrasound exam k transpl w/doppler
|
$671.58 |
$671.58 |
$671.58 |
$556.00
|
|
Ultrasound joint complete left
|
$371.70 |
$371.70 |
$371.70 |
$557.99
|
|
Ultrasound joint/nonvascular extremity limited left
|
$275.94 |
$275.94 |
$275.94 |
$455.00
|
|
Ultrasound scrotum and contents
|
$840.42 |
$840.42 |
$840.42 |
$614.40
|
|
Unlisted ultrasound procedure
|
$664.02 |
$664.02 |
$664.02 |
$346.00
|
|
Unsched dialysis esrd pt hos
|
$1,685.88 |
$1,685.88 |
$1,685.88 |
$1,465.59
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,854.72 |
$1,854.72 |
$1,854.72 |
$2,013.08
|
|
Urea nitrogen
|
$63.00 |
$63.00 |
$63.00 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$34.65 |
$34.65 |
$34.65 |
$49.50
|
|
Urea nitrogen clearance
|
$68.67 |
$68.67 |
$68.67 |
$33.57
|
|
Uric acid blood
|
$53.55 |
$53.55 |
$53.55 |
$46.75
|
|
Uric acid urine
|
$34.65 |
$34.65 |
$34.65 |
$47.40
|
|
Urinalysis microscopic only
|
$37.17 |
$37.17 |
$37.17 |
$25.85
|
|
Urinalysis (with microscopy)
|
$6.30 |
$6.30 |
$6.30 |
$48.14
|
|
Urinalysis (without microscopy)
|
$68.04 |
$68.04 |
$68.04 |
$38.99
|
|
Urine Culture Test
|
$81.27 |
$81.27 |
$81.27 |
$83.00
|
|
Urine pregnancy test
|
$143.64 |
$143.64 |
$143.64 |
$66.40
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$70.66 |
$70.66 |
$70.66 |
$42.81
|
|
Vaccine hepatitis a (hepa) adult im
|
$133.83 |
$133.83 |
$133.83 |
$166.44
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$619.84 |
$619.84 |
$619.84 |
$162.07
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$553.70 |
$553.70 |
$553.70 |
$157.41
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$22.54 |
$22.54 |
$22.54 |
$43.55
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$283.37 |
$283.37 |
$283.37 |
$55.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,448.60 |
$1,448.60 |
$1,448.60 |
$442.48
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$206.21 |
$206.21 |
$206.21 |
$411.74
|
|
Vaccine mmr live subcutaneous
|
$172.66 |
$172.66 |
$172.66 |
$222.36
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$608.10 |
$608.10 |
$608.10 |
$633.56
|
|
Valproic acid total therapeutic drug level
|
$65.52 |
$65.52 |
$65.52 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$204.01 |
$204.01 |
$204.01 |
$138.69
|
|
Vancomycin 750 mg intravenous solution
|
$432.28 |
$432.28 |
$432.28 |
$132.65
|
|
Vancomycin peak therapeutic drug level
|
$77.49 |
$77.49 |
$77.49 |
$123.50
|
|
Ventilator each subsequent day
|
$1,458.66 |
$1,458.66 |
$1,458.66 |
$1,290.00
|
|
Ventilator initial day
|
$1,566.53 |
$1,566.53 |
$1,566.53 |
$1,473.00
|
|
Viper venom prothrombin time
|
$119.70 |
$119.70 |
$119.70 |
$35.20
|
|
Vital capacity test
|
$250.74 |
$250.74 |
$250.74 |
$170.00
|
|
Vitamin b-12
|
$11.34 |
$11.34 |
$11.34 |
$93.00
|
|
Vitamin D Test
|
$193.41 |
$193.41 |
$193.41 |
$132.00
|
|
Volume measurement urine timed
|
$25.83 |
$25.83 |
$25.83 |
$22.40
|
|
Warde 1003990 aldosterone
|
$403.83 |
$403.83 |
$403.83 |
$151.47
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$252.63 |
$252.63 |
$252.63 |
$72.50
|
|
Warde 3008005 oligoclonal bands
|
$91.98 |
$91.98 |
$91.98 |
$109.58
|
|
Warde 3016000 west nile virus antibody
|
$90.16 |
$90.16 |
$90.16 |
$75.40
|
|
Warde 3016000 west nile virus antibody igg
|
$102.24 |
$102.24 |
$102.24 |
$72.00
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$48.30 |
$48.30 |
$48.30 |
$57.24
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$181.44 |
$181.44 |
$181.44 |
$63.48
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$151.20 |
$151.20 |
$151.20 |
$79.30
|
|
Warde aldolase
|
$105.21 |
$105.21 |
$105.21 |
$52.80
|
|
Warde amino acids 6 or more quantitative each specimen
|
$202.86 |
$202.86 |
$202.86 |
$180.51
|
|
Warde anti-mullerian hormone
|
$120.33 |
$120.33 |
$120.33 |
$100.00
|
|
Warde apolipoprotein b
|
$65.52 |
$65.52 |
$65.52 |
$64.28
|
|
Warde complement total hemolytic
|
$255.19 |
$255.19 |
$255.19 |
$107.80
|
|
Warde copper
|
$168.84 |
$168.84 |
$168.84 |
$82.40
|
|
Warde cryoglobulin
|
$83.16 |
$83.16 |
$83.16 |
$44.20
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$34.65 |
$34.65 |
$34.65 |
$49.20
|
|
Warde hemoglobin fractionation/quantitation electrophoresis
|
$194.04 |
$194.04 |
$194.04 |
$76.70
|
|
Warde hepatitis a antibody
|
$76.48 |
$76.48 |
$76.48 |
$82.00
|
|
Warde protein c antigen
|
$167.58 |
$167.58 |
$167.58 |
$86.39
|
|
Warde sex hormone binding globulin
|
$146.79 |
$146.79 |
$146.79 |
$97.50
|
|
Warde virus isolation tissue culture innoculation presumptive id herpes simplex
|
$158.13 |
$158.13 |
$158.13 |
$129.60
|
|
Warde vitamin b-1 (thiamine)
|
$141.75 |
$141.75 |
$141.75 |
$83.99
|
|
Warde vitamin b6 (pyridoxine)
|
$114.66 |
$114.66 |
$114.66 |
$126.10
|
|
Warde vitamin d (1 25 dihydroxy)
|
$324.45 |
$324.45 |
$324.45 |
$153.00
|
|
Warde zinc
|
$175.77 |
$175.77 |
$175.77 |
$63.04
|
|
Wbc automated
|
$44.10 |
$44.10 |
$44.10 |
$33.57
|
|
Whole blood for transfusion
|
$1,548.40 |
$1,548.40 |
$1,548.40 |
$462.00
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$509.12 |
$509.12 |
$509.12 |
$769.45
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$514.50 |
$514.50 |
$514.50 |
$475.80
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$365.40 |
$365.40 |
$365.40 |
$524.00
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$365.40 |
$365.40 |
$365.40 |
$582.55
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$230.58 |
$230.58 |
$230.58 |
$287.00
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$405.72 |
$405.72 |
$405.72 |
$414.70
|
|
Wrist X-ray
|
$552.51 |
$552.51 |
$552.51 |
$350.40
|
|
X-ray abdomen 1 view
|
$219.24 |
$219.24 |
$219.24 |
$254.80
|
|
X-ray abdomen 2 views
|
$267.12 |
$267.12 |
$267.12 |
$312.00
|
|
X-ray abdomen >=3 views
|
$421.47 |
$421.47 |
$421.47 |
$331.54
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$723.24 |
$723.24 |
$723.24 |
$406.90
|
|
X-ray ankle 2 views (both sides)
|
$81.90 |
$81.90 |
$81.90 |
$283.00
|
|
X-ray bone survey complete
|
$1,117.62 |
$1,117.62 |
$1,117.62 |
$660.00
|
|
X-ray cervical spine 2-3 views
|
$127.26 |
$127.26 |
$127.26 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$176.40 |
$176.40 |
$176.40 |
$453.04
|
|
X-ray cervical spine >= 6 views
|
$287.28 |
$287.28 |
$287.28 |
$512.20
|
|
X-ray clavicle complete (both sides)
|
$145.53 |
$145.53 |
$145.53 |
$297.22
|
|
X-ray elbow 2 views (both sides)
|
$185.85 |
$185.85 |
$185.85 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$373.59 |
$373.59 |
$373.59 |
$338.62
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$635.67 |
$635.67 |
$635.67 |
$484.80
|
|
X-ray exam thorac spine4/>vw
|
$808.92 |
$808.92 |
$808.92 |
$378.95
|
|
X-ray femur >=2 views (both sides)
|
$590.31 |
$590.31 |
$590.31 |
$304.90
|
|
X-ray finger(s) >= 2 views (both sides)
|
$145.53 |
$145.53 |
$145.53 |
$260.15
|
